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5150 patient absconded from the ER........

CHP initiated a 5150 on a psych pt and called the ambulance for transport. Medic says pt needs medical clearance and brings him to us instead of taking him to a psych facility. We are a 6-bed ER, with two RNs and a tech on at a time. My coworker and the tech were behind a door taking care of a sick baby, so I had the rest of the ER. CHP decided that he didn't need to stay to babysit the pt so he said "Call me if you need me." Like a fool I let him go. I checked on the pt frequently, even got him a dinner tray. Fifteen minutes later his bed was empty and he was gone, along with the knife from the tray. I started storming about how I shouldn't have let the cop leave, and the doc tried to pin it on me! Yes, I bear some of the responsibility, but how was I supposed to babysit him and take care of the other 4 pts???

Yes, I called dispatch, and I also called my manager. She is supporting me but I have been kicking myself with "I should have's" and "What if's?"

ARRGHHH! :banghead: :banghead: :banghead:

CritterLover, BSN, RN

Has 21 years experience. Specializes in ER, ICU, Infusion, peds, informatics.

chp decided that he didn't need to stay to babysit the pt so he said "call me if you need me." like a fool i let him go.

easy to beat yourself up for this. don't. the chp officer deserves as much (but probably more, much more) responsibility for leaving the patient. your responsibility was medical care/assisting with medical clearance. not babysitting. if a prisoner needs to be baby-sat (and what prisoner doesn't?), then a police officer needs to do the baby-sitting. period. end of story. he never should have left, and i'd bet that you didn't enourage it ("oh, just go ahead and go...he'll be fine, i'll watch him, i promise"....while batting your eyelashes, right?)

chp decided that he didn't need to stay to babysit the pt so he said "call me if you need me." like a fool i let him go.

easy to beat yourself up for this. don't. the chp officer deserves as much (but probably more, much more) responsibility for leaving the patient. your responsibility was medical care/assisting with medical clearance. not babysitting. if a prisoner needs to be baby-sat (and what prisoner doesn't?), then a police officer needs to do the baby-sitting. period. end of story. he never should have left, and i'd bet that you didn't enourage it ("oh, just go ahead and go...he'll be fine, i'll watch him, i promise"....while batting your eyelashes, right?)

who......me??? *batting eyelashes*

:rotfl:

no. and the doc's argument was that the pt was not under arrest. my argument was that chp initiated the 5150 so he should have stayed.

CritterLover, BSN, RN

Has 21 years experience. Specializes in ER, ICU, Infusion, peds, informatics.

my argument was that chp initiated the 5150 so he should have stayed.

exactly. so he had better things to do. so did you (or did those other four patients not need nursing care? 'cause if you were goinging to babysit him, thats all you would have done.)

exactly. so he had better things to do. so did you (or did those other four patients not need nursing care? 'cause if you were goinging to babysit him, thats all you would have done.)

okay, okay.....i'll stop with the self-booting.....

What is a 5150?

And I would need to see written policy from your manager on exactly how this type of situation needs to be handled, for future reference.

If it was not the officer's responsibility to keep him in the ER, if it wasn't yours, whose was it? Maybe no one's and he was genuinely free to go?

5150 is the CA state code for someone who is a danger to himself or others and needs to be commited involuntarily. No, he was not free to go. I say it was CHP's responsibility since they were the one who initiated the hold. Doc says CHP didn't need to stay because he wasn't under arrest. No, we do not have a written policy. Manager is going to a seminar next month about 5150s and is going to bring up this situation and ask what our liability.

I am sorry that that happened. We are a rural ER without a psych facilty as well. But we have a few more beds. Our policy recently changed regarding 5150's. We were told by our hospital that we cannot physically make a 5150 stay for medical clearance. If they try and leave we can only encourage them to stay, but never are we to try and physically make them do anything. We questioned this especially if they were 5150 by PD or suicidal, danger to others ect... We were told that PD would have to be the only ones to make the pt do anything. We stated that they didn't have time for that. We were told thats really not our problem, PD needs to be present to enforce. If the pt leaves we are to notify PD as soon as they leave and it's up to PD to bring them back. Was it plastic utensils or metal? Don't beat yourself up. There needs to be a policy. Keep us updated on what your Magaer gets out of the seminar....

pywon8

Specializes in medical, surgical ,high dependency unit.

Ohh...dear...How can a police leave the psyc patient in the ER with all the patients, nurses and Doctors...It is not right for a police to do so. The police should know the psyc patient will harm the surrounded people anytime. Well, what I think is you should get your supervisor informed about the patient just after they reach here next time. At least maybe your supervisor can arrange another person to take care of the patient. well....just for safety purpose. However,I agree with you that.....the police should not and never ever leave the patient like that....what a irresponsible police. well...trust me....you are a very responsible nurse as you know you are busy but still keep on eye to the patient.. its just that...not a right time.....keep it up!! :yeah:

I am sorry that that happened. We are a rural ER without a psych facilty as well. But we have a few more beds. Our policy recently changed regarding 5150's. We were told by our hospital that we cannot physically make a 5150 stay for medical clearance. If they try and leave we can only encourage them to stay, but never are we to try and physically make them do anything. We questioned this especially if they were 5150 by PD or suicidal, danger to others ect... We were told that PD would have to be the only ones to make the pt do anything. We stated that they didn't have time for that. We were told thats really not our problem, PD needs to be present to enforce. If the pt leaves we are to notify PD as soon as they leave and it's up to PD to bring them back. Was it plastic utensils or metal? Don't beat yourself up. There needs to be a policy. Keep us updated on what your Magaer gets out of the seminar....

That's another reason I'm kicking myself....I knew better than to give him regular utensils and I just wasn't thinking. I know that we can't make a 5150 stay, but if he had been observed he probably would not have left and if he had tried one of us could have called dispatch while another tried to talk to him. There are lots of things that, looking back I could have or should have done.

santhony44, MSN, RN, NP

Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.

What would you have done if you had been standing there when the patient started to leave? Could you have possibly been injured in the process?

It's probably just as well for you that you weren't between the patient and the door.

I would think that it's the officer's responsibility, not yours, to prevent the patient from leaving. It will be interesting to find out what your manager hears in the workshop.

What would you have done if you had been standing there when the patient started to leave? Could you have possibly been injured in the process?

It's probably just as well for you that you weren't between the patient and the door.

I would think that it's the officer's responsibility, not yours, to prevent the patient from leaving. It will be interesting to find out what your manager hears in the workshop.

Read my last post again.

In my entire career I have never had a 5150 who was a danger to others, only to themselves. I'm not stupid enough to have put myself in dangerous proximity with him, but he was not a danger to others. He has a looooong psych history and had absconded from a halfway house in another county yesterday morning. If he was a danger to others I would have insisted that the cop stay, but I doubt he would have thought it was safe to leave in that case.

jojotoo, RN

Specializes in Emergency.

That's another reason I'm kicking myself....I knew better than to give him regular utensils and I just wasn't thinking. I know that we can't make a 5150 stay, but if he had been observed he probably would not have left and if he had tried one of us could have called dispatch while another tried to talk to him. There are lots of things that, looking back I could have or should have done.

Actually you can make a 5150 stay. We have a locked psych floor in our hospital and 99% of the patients admitted there are medically cleared through the ER. Sometimes they are in the ER for several days before a bed opens up on the psych unit. This does not make for a very comfortable stay for the psych patients. But they are not free to leave. We use a combination of CNAs or ER techs as sitters. After a certain point, if we are holding too many in the ER, we get an extra RN to help watch them. We use Haldol, Ativan, Benadryl, Geodon and Restoril to try to keep everyone calm. But it is a rare 24 hr period that somebody is not in leather restraints until a "cocktail" kicks in. We also have an occasional escape. But is usually witnessed - the patient was just faster getting to the door than us. A foot chase by ER staff and/ or security ensues. We catch them, drag them back, restrain them and medicate them. If they truly get away, we notify local PD and they start searching for them.

The 5150 is a LEGAL hold, not a medical hold. It doesn't matter if he was a danger to himself or someone else, a judge decided he needed to go to psych and the cops were responsible for enforcing that. He was only in the ER for medical clearance, that was your role.

So what, you gave him metal utencils - oops - I don't know about your hospital, but we don't serve steaks and definetly no trays with steak knives, just butter knives!!!

Relax, let me buy you a drink

santhony44, MSN, RN, NP

Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.

Read my last post again.

In my entire career I have never had a 5150 who was a danger to others, only to themselves. I'm not stupid enough to have put myself in dangerous proximity with him, but he was not a danger to others. He has a looooong psych history and had absconded from a halfway house in another county yesterday morning. If he was a danger to others I would have insisted that the cop stay, but I doubt he would have thought it was safe to leave in that case.

I wasn't saying that you're stupid. I was saying that I've seen people so determined to leave that they were willing to run over whoever was between them and the door. You can get hurt just being pushed out of the way.

It is fascinating that your facility has no written policy about this. This surely is not the first time this has come up.

Is a 5150 a Court ordered patient? I thought you said this person was just brought in by cops. No arrest. Just cops saw him, thought he was in need of Psych eval/Med eval, and brought him in.

As for someone being dangerous only to himself - no way to be absolutely certain. The calmest, sweetest animal will kill if pushed hard enough.

Actually you can make a 5150 stay. We have a locked psych floor in our hospital and 99% of the patients admitted there are medically cleared through the ER. Sometimes they are in the ER for several days before a bed opens up on the psych unit. This does not make for a very comfortable stay for the psych patients. But they are not free to leave. We use a combination of CNAs or ER techs as sitters. After a certain point, if we are holding too many in the ER, we get an extra RN to help watch them. We use Haldol, Ativan, Benadryl, Geodon and Restoril to try to keep everyone calm. But it is a rare 24 hr period that somebody is not in leather restraints until a "cocktail" kicks in. We also have an occasional escape. But is usually witnessed - the patient was just faster getting to the door than us. A foot chase by ER staff and/ or security ensues. We catch them, drag them back, restrain them and medicate them. If they truly get away, we notify local PD and they start searching for them.

Are you at Olive View? LAC-USC?

No, we can't make a 5150 stay. We are not a psych facility so whenever we have a 5150 we have to transfer to another facility (nearest one is an hour away) for a psych clearance. They either admit the pt on a hold to inpt or release from the ER.

Yes, it's a legal hold but it's not enforced by a court. Most of ours are initiated by the ER doc and is either cancelled or reinforced by psych on their eval. Every once in a while, like last night, it's initiated by law enforcement.

Most of our hold are not violent but depressed; they don't do anything and do not protest when someone is watching them.

Yes, it was just a table knife, with just the tip serrated, but someone who is depressed can do plenty of damage to themselves with that.

This particular pt could have easily been transported straight to psych for a mental health eval since CHP started the 5150, but the medic on duty is well known for bringing all pts to our ER because she insists the pt be medically cleared first.

I'll take that drink but can you make it a root beer? I'd just as soon not mess up my sobriety. :cheers:

West_Coast_Ken, BSN, RN

Specializes in Case Manager, Home Health.

He...had absconded from a halfway house in another county yesterday morning.

RN = Medical care

CHP = Enforcement

Seems clear to me who's responsible for this pt running off and it's not you. Also, did the officer know about the pt running off the day before? If so that's another stike against him/her.

RN = Medical care

CHP = Enforcement

Seems clear to me who's responsible for this pt running off and it's not you. Also, did the officer know about the pt running off the day before? If so that's another stike against him/her.

Oh yeah! He even called the facility and they told him he was not welcome back. His reasoning for leaving was that the pt was cooperative (to a point...we had to explain everything very clearly and rationalize it before he would let us touch him) so we should be able to handle it.

5150's are supposed to be placed in the room closest to the desk but we were full. Plus I was overextended because my fellow nurse was tied up with a 1:1. Yes, I know that I did all I could personally but I'm kicking myself because I should have either insisted the cop stay, or I should have insisted the house supe find me a sitter. I did neither because I let myself be talked out of it.

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